<fieldset>
<legend><?php echo JText::_('Renew Account Parrams')?></legend>
	<table>
		<tr>
			<td><?php echo '{line-break}' ;?></td>
			<td width='10'>:</td>
			<td>Line break</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{username}') ;?></td>
			<td width='10'>:</td>
			<td>Username</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{f_name}') ;?></td>
			<td width='10'>:</td>
			<td>First name</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{l_name}') ;?></td>
			<td width='10'>:</td>
			<td>Last name</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{name_on_card}') ;?></td>
			<td width='10'>:</td>
			<td>Name as of appears on card</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{dob}') ;?></td>
			<td width='10'>:</td>
			<td>Day of birth</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{phone}') ;?></td>
			<td width='10'>:</td>
			<td>Mobile phone number</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{address}') ;?></td>
			<td width='10'>:</td>
			<td>Address</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{country}') ;?></td>
			<td width='10'>:</td>
			<td>Country</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{city}') ;?></td>
			<td width='10'>:</td>
			<td>City</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{district}') ;?></td>
			<td width='10'>:</td>
			<td>District</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{pick_up_at}') ;?></td>
			<td width='10'>:</td>
			<td>Pick up outlet</td>
		</tr>
		<tr>
			<td><?php echo JText::_('{outlet_address}') ;?></td>
			<td width='10'>:</td>
			<td>Outlet address</td>
		</tr>
	</table>
</fieldset>